83R7637 BEF-D
By: Bonnen of Galveston H.B. No. 2700
A BILL TO BE ENTITLED
AN ACT
relating to the requirement that certain health care providers give
patients a good faith estimate of the expected payment for health
care services and goods before the services or goods are provided;
providing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 3, Occupations Code, is
amended by adding Chapter 117 to read as follows:
CHAPTER 117. GOOD FAITH ESTIMATE OF HEALTH CARE PAYMENTS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 117.001. DEFINITIONS. In this chapter:
(1) "Department" means the Department of State Health
Services.
(2) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(3) "Health care provider" means:
(A) a health care professional who performs a
health care service or provides a health care good in this state
under a license, certificate, registration, or other authority
issued by this state to diagnose, prevent, alleviate, or cure a
human illness or injury, including a physician, dentist, pharmacy,
or pharmacist;
(B) a health care facility that provides a health
care service or good in this state under a license, certificate,
registration, or other authority issued by this state to diagnose,
prevent, alleviate, or cure a human illness or injury, including an
institutional health care provider or other hospital; or
(C) a person that provides to patients in this
state ancillary health care-related services and goods under a
license, certificate, or registration issued by this state, or that
is otherwise authorized to provide to patients in this state
ancillary health care-related services and goods ordered or
authorized by a licensed health care professional, to diagnose,
prevent, alleviate, or cure a human illness or injury, including
laboratory services, radiological services, and durable medical
equipment.
SUBCHAPTER B. ADMINISTRATION OF CHAPTER
Sec. 117.051. ADMINISTRATION BY LICENSING ENTITIES. (a)
The governing body of the entity that issues a license,
certificate, registration, or other authorization to practice to a
health care provider shall administer and enforce this chapter as
it applies to the provider.
(b) A governing body described by Subsection (a) may adopt
rules governing the application of this chapter to health care
providers regulated by the entity.
Sec. 117.052. ADMINISTRATION BY DEPARTMENT. (a) The
department shall administer and enforce this chapter as it applies
to any health care provider not issued a license, certificate,
registration, or other authorization to practice described by
Section 117.051.
(b) The executive commissioner shall adopt rules governing
the application of this chapter to a health care provider described
by Subsection (a).
SUBCHAPTER C. GOOD FAITH ESTIMATE
Sec. 117.101. GOOD FAITH ESTIMATE REQUIRED. (a) Except as
provided by Subsection (b), before a health care provider provides
to a person a health care service or a health care good, including a
drug or medical device, the health care provider must provide the
person a good faith estimate of the actual expected payments for the
service or good, as provided by this subchapter. The health care
provider shall ask the person to disclose the person's anticipated
method of payment for purposes of complying with this subchapter.
(b) A health care provider shall:
(1) in an emergency or urgent medical situation,
provide to a person any health care service or health care good
necessary to stabilize the person's medical condition if delay
required to provide a good faith estimate of the actual payment for
the service or good under Subsection (a) could result in an adverse
medical consequence to the person; or
(2) provide to a person a health care service or health
care good ordered by the person's physician or other person
primarily responsible for the person's care if the person is unable
to make medical decisions and does not have a legal representative
to make medical decisions on the person's behalf.
Sec. 117.102. GOOD FAITH ESTIMATE FOR INSURED PERSONS. If a
person has an individual, group, or other private or commercial
health insurance plan or policy, including coverage through a
preferred provider organization or health maintenance
organization, a health care provider shall provide the person a
good faith estimate of:
(1) the amount the insurance plan or policy will
actually pay the health care provider for the health care service or
health care good based on the negotiated rate between the health
care provider and the insurance plan or policy; and
(2) the amount of any copayment, coinsurance, or other
amount the person will actually pay the health care provider for the
health care service or health care good based on the terms of the
person's insurance plan or policy and the negotiated rate between
the health care provider and the person's insurance plan or policy.
Sec. 117.103. GOOD FAITH ESTIMATE FOR RECIPIENTS OF
GOVERNMENT-SPONSORED PROGRAM. If a person receives benefits under
a government-sponsored health benefits program, including the
Medicaid program, the Medicare program, the Children's Health
Insurance Program (CHIP), and the TRICARE military health system, a
health care provider shall provide the person a good faith estimate
of:
(1) the amount the government-sponsored health
benefits program will actually pay the health care provider for the
health care service or health care good; and
(2) any amount the person will actually pay the health
care provider for the health care service or health care good under
the terms of the government-sponsored health benefits program.
Sec. 117.104. GOOD FAITH ESTIMATE FOR RECIPIENTS OF
WORKERS' COMPENSATION BENEFITS. If a person receives benefits under
a workers' compensation claim, a health care provider shall provide
the person a good faith estimate of the amount the workers'
compensation insurance carrier will actually pay the health care
provider for the health care service or health care good.
Sec. 117.105. STATEMENT FOR PERSONS PAYING CASH, PERSONS
RECEIVING CHARITY CARE, AND INDIGENT PERSONS. If a person will pay
cash or will receive charity care for a health care service or
health care good or if a person is indigent, a health care provider
shall provide the person with a statement of the average amount the
health care provider was actually paid for the health care service
or health care good by the five insurance carriers or
government-sponsored programs described by Sections 117.102,
117.103, and 117.104 that paid the health care provider for the
greatest number of that health care service or health care good in
the preceding calendar year, or in the current calendar year if the
health care provider did not practice in the preceding calendar
year.
SUBCHAPTER D. AGREEMENT TO PROVIDE GOOD FAITH ESTIMATE ON BEHALF OF
ANOTHER HEALTH CARE PROVIDER
Sec. 117.151. CONTRACT TO ALLOW ANOTHER HEALTH CARE
PROVIDER TO PROVIDE GOOD FAITH ESTIMATE. (a) A health care provider
may by contract agree to allow another health care provider to
provide a good faith estimate under Subchapter C for that health
care provider's health care services and health care goods.
(b) A health care provider who enters into a contract
described by Subsection (a) is responsible for the content of the
good faith estimate provided by the other health care provider on
that provider's behalf.
Sec. 117.152. RULES GOVERNING CONTRACTING. (a) The
executive commissioner may adopt rules governing contracts under
Section 117.151.
(b) The department shall administer rules described by
Subsection (a).
SUBCHAPTER E. PENALTIES AND ENFORCEMENT
Sec. 117.201. VIOLATION BY LICENSED HEALTH CARE PROVIDERS. A
health care provider that violates this chapter is subject to an
administrative penalty, a civil penalty, or other disciplinary
action, as applicable, in the same manner as if the health care
provider violated the law under which the health care provider is
licensed, certified, registered, or authorized to practice.
Sec. 117.202. VIOLATION BY OTHER HEALTH CARE PROVIDERS.
(a) The executive commissioner or department may impose an
administrative penalty against a health care provider that is not
required to hold a license, certificate, registration, or other
authorization to practice and that violates this chapter.
(b) An administrative penalty imposed under this section
shall be imposed in the same manner as other administrative
penalties imposed by the executive commissioner.
(c) The amount of the penalty may not exceed $1,000 for each
violation.
(d) The executive commissioner may adopt rules to implement
this section.
SECTION 2. The changes in law made by this Act apply only to
a health care service or health care good ordered or provided on or
after the effective date of this Act. A health care service or
health care good ordered or provided before the effective date of
this Act is governed by the law in effect on the date the service or
good was ordered or provided, and the former law is continued in
effect for that purpose.
SECTION 3. This Act takes effect September 1, 2013.